SLR - August 2014 - Steven Gillespie

Clinical Characteristics of Foot Ulceration in People with Chronic Gout

Reference: Rome K, Erikson K, Otene C, Sahid H, Sangster K, Gow P. Clinical Characteristics of Foot Ulceration in People with Chronic Gout. Int Wound J. 2014 Mar 28. doi: 10.1111/iwj.12262

Scientific Literature Review

Reviewed By: Steven Gillespie, DPM
Residency Program: Southern Arizona VA Health Care System

Podiatric Relevance: Gout is a common inflammatory arthritis which often manifests in the foot and is commonly seen in patients with co-morbidities such as diabetes and cardiovascular disease. The effect of gout on foot ulcerations has not previously been well-studied. 

Methods: Participants were recruited from rheumatology clinics in Auckland, New Zealand. All the current foot ulceration sites and wound characteristics were recorded using the TIME wound assessment tool. The outcome measures included general pain, patient global assessment scale, foot pain, disability and impairment. Participants completed the Cardiff Wound Impact Schedule to assess the effect of ulcers on health-related quality of life. Sensory loss, vibrational thresholds and ankle brachial pressure index were collected to assess for lower limb arterial disease.

Results: The mean duration of the wounds was four months, with all participants having an ulceration on at least one toe. Gouty tophi was evident in most of the wounds and subcutaneous tophi affecting the 1st MTPJ in most participants. The dorsal aspect of the third toe was found to ulcerate in most cases. Most participants wore shoes that demonstrated poor footwear characteristics.

Conclusions: Foot ulceration in gout is chronic and multiple ulcers can occur with the potential of leading to delayed wound healing, infection and a reduced quality of life. Poor footwear may contribute to the development and delayed healing of ulceration in people with gout.

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